<!DOCTYPE html>
<html>

<head>
  <meta charset="utf-8">
  <title>绑定</title>
  <meta name="apple-mobile-web-app-capable" content="yes">
  <meta name="apple-mobile-web-app-status-bar-style" content="black">
  <script src="../js/set-meta.js"></script>
  <link rel="stylesheet" type="text/css" href="../css/bind.css"/>
</head>

<body>

		<header class="mui-bar-nav mui-bar-nav-1">
				<a class="mui-action-back mui-icon mui-icon-left-nav mui-pull-left"></a>
				<p class="mui-title mui-pull-left">绑定</p>
				<p class="submitBtn" id="submitBtn">提交</p>
		</header>
		
		<div class="mui-content">
				<div class="info-content" id="parentPart">
						<p class="info-content-title">老人信息</p>
						<ul class="fill-list">
							<li class="fill-row mui-input-row">
								<span class="title mui-pull-left">姓名：</span>
								<input type="text" class="mui-input-clear mui-input" name="" id="parentName" value="" placeholder="请输入老人的名字"/>
							</li>
							<li class="fill-row mui-input-row">
								<span class="title mui-pull-left">身份证：</span>
								<input type="number " class="mui-input-clear mui-input" name="" id="parentID" value="" placeholder="请输入老人的身份证号码"/>
							</li>
							<li class="fill-row mui-input-row">
								<span class="title mui-pull-left">手机号：</span>
								<input type="number" class="mui-input-clear mui-input" name="" id="parentPhone" value="" placeholder="请输入老人的手机号"/>
							</li>
						</ul>
						<ul class="id-card-part mui-clearfix">
							<li class="id-card-row mui-pull-left">
								<p class="title">身份证正面：</p>
								<img src="../images/add_pic.jpg" alt="" id="x"/>
							</li>
							<li class="id-card-row mui-pull-left">
								<p class="title">身份证反面：</p>
								<img src="../images/add_pic.jpg" alt="" />
							</li>
						</ul>
				</div>
				
				<div class="info-content" id="selfPart">
						<p class="info-content-title">本人信息</p>
						<ul class="fill-list">
							<li class="fill-row mui-input-row">
								<span class="title mui-pull-left">姓名：</span>
								<input type="text" class="mui-input-clear mui-input"  name="" id="selfName" value="" placeholder="请输入本人名字"/>
							</li>
							<li class="fill-row mui-input-row">
								<span class="title mui-pull-left">身份证：</span>
								<input type="number " class="mui-input-clear mui-input"  name="" id="selfID" value="" placeholder="请输入本人身份证号码"/>
							</li>
							
							<!--<li class="fill-row">
								<span class="title mui-pull-left">手机号：</span>
								<input type="number" name="" id="selfPhone" value="" placeholder="请输入本人手机号"/>
							</li>-->
						</ul>
						<ul class="id-card-part mui-clearfix">
							<li class="id-card-row mui-pull-left">
								<p class="title">身份证正面：</p>
								<img src="../images/add_pic.jpg" alt="" />
							</li>
							<li class="id-card-row mui-pull-left">
								<p class="title">身份证反面：</p>
								<img src="../images/add_pic.jpg" alt="" />
							</li>
						</ul>
				</div>
		</div>
		<!--<canvas></canvas>-->
		<div id="actionSheet">
				<div id="actionBtn">
						<a href="javascrit:;" id="Image">拍照上传</a>
						<a href="javascrit:;" id="Gallery">相册选取</a>
						<a href="javascrit:;" id="Cancel">取消</a>
				</div>
		</div>
<script src="../js/lrz.bundle.js" ></script>
<script src="../js/bind.js"></script>

</body>

</html>